There are currently 40 to 50 million individuals living with disabilities in the U.S. and the number of adults with disabilities is expected to rise in the coming years. Although studies over the last decade have demonstrated that individuals with disabilities are at a significantly higher risk for nonfatal injuries, much remains to be learned about the risks and patterns of occupational and non-occupational injuries in workers with disabilities. The long-term goal of this project is to study associations between pre-existing disabilities and secondary injuries and to investigate the medical costs and methods of payments among U.S. workers with disabilities. The central hypotheses are (1) that workers with disabilities are at a significantly higher risk for occupational and non-occupational injuries than workers without disabilities, and (2) that the annual costs associated with medical care for these injuries are significantly higher in workers with disabilities. The rationale for the proposed research is that understanding the relationship between pre-existing disability and secondary injury and identifying injury patterns will allow for the development of better evidence-based policies and safety programs for U.S. workers with disabilities. Thus, the proposed research will help promote the NIOSH mission to address occupational safety and health disparities in special populations. Data from two large representative national surveys - the 1997-2004 National Health Interview Survey, and the 2002-2006 Medical Expenditure Panel Survey, will be analyzed to pursue three specific aims: 1) To compare occupational injuries and non-occupational injuries among U.S. workers with and without disabilities; 2) To compare the medical service costs for treating occupational injuries and non- occupational injuries among U.S. workers with and without disabilities; and 3) To compare sources of payments and out-of-pocket expenditures for the medical treatment of occupational injuries and non- occupational injuries among U.S. workers with disabilities and without disabilities. Guided by our strong preliminary data, this study will use several innovative statistical approaches. Association between pre-existing disabilities and occupational injuries and non-occupational injuries will be studied using multivariable logistic regression and Poisson regression models controlling for demographic and socioeconomic injury risk factors. Medical costs of occupational injuries and non- occupational injuries will be compared between U.S. workers with and without disabilities using bootstrap methods and a two-part regression model. Findings from the proposed research could provide much-needed scientific evidence for informing important policy decisions relevant to occupational safety and injury prevention among U.S. workers with disabilities. PUBLIC HEALTH RELEVANCE: Both Healthy People 2010 and the 2005 U.S. Surgeon General's Call to Action to Improve the Health and Wellness of Persons with Disabilities identified health promotion and the integration of individuals into the community as national priorities. This study will answer several fundamental questions about risks, patterns, and medical costs of occupational injuries and non-occupational injuries among U.S. Workers with disabilities. Our research will promote the NIOSH mission to address occupational safety and health disparities in special populations and addresses several sections of Healthy People 2010 (Section 20.2: to reduce work-related injuries resulting medical treatment, lost time from work, or restricted work activities; Section 6: To promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities). Healthy People Objectives contains several occupational safety objectives. However, those objectives lack specific objectives for workers with disabilities. The Healthy People 2020 Disability and Health Workgroup is developing a new objective to eliminate disparities in the percentage of children, youth, and adults with and without disabilities who report medically treated nonfatal unintentional injuries. Our proposed study on occupational injury is of utmost importance to help grow the scientific knowledge in the crosscutting fields of disability, unintentional injury, and occupational safety. Findings from this study have the potential to translate into better evidence-based policies and safety programs that will promote occupational safety and health among Workers with disabilities in the United States.